Eligibility Requirements and Application
for
Licensure and Certification


Licensure/Certification will be awarded at three progressive levels:


Minimum eligibility requirements include:

Upon certification, CapacityWare may be licensed, or data processing work may be processed by QWLC or an eligible mentor-agent.


Licensure and Certification Application


PART A
Personal Information

A1. NAME:
A2. LINE 1 STREET ADDRESS:
A3. LINE 2 STREET ADDRESS:
A4. CITY: A5. STATE: A6. ZIP:
and/or
A7. PROVINCE: A8. COUNTRY: if not USA.

A9. EMPLOYER:
A10. PROFESSION:

A11. E-MAIL:
A12. FAX:
A13. WEB SITE:


A14. I MAY BE AVAILABLE FOR TEAMING WITH OTHER CERTIFIED INDIVIDUALS -
YES - NO - MAYBE .

A15. THIS APPLICATION IS INTENDED TO PURSUE THE FOLLOWING LICENSURE/CERTIFICATION LEVELS:
WORKSHOP, PRACTITIONER, MASTERY.


PART B
Connection or Introduction

B1. RGB OR RELATED WORKSHOP DATE(S): ,
B2. LOCATION: , and
B3. FACILITATOR(S) or TEAM:

B4. DESCRIPTION OF MOTIVATION TO ADVANCE RGB UNDERSTANDING:



PART C
Entrepreneurial Experience

C1. DESCRIBE THE Entrepreneurial EXPERIENCE YOU HAVE HAD WITH THE CLIENT BASE YOU PRIMARILY INTEND TO SERVE.


C2. DESCRIBE YOUR SUCCESSFUL EXPERIENCES IN MARKETING SOFT-SERVICES TO A SPECIFIC CLIENT BASE:



PART D
Computer Literacy and Current Applications Package(s)

D1. CERTIFY THAT YOU HAVE MS OFFICE SUITE (PROFESSIONAL VERSION) ON THE PRIMARY COMPUTER WHERE CAPACITYWARE SOFTWARE WILL RESIDE. YES or NO.

D2. PROVIDE A DETAILED STATEMENT THAT DESCRIBES YOUR LEVEL OF FAMILIARITY WITH THE ADVANCED FEATURES OF MS OFFICE PROFESSIONAL SUITE.


PART E
Facilitation Experience

E1. APPROXIMATE NUMBER OF GROUPS FACILITATED:
E2. DATE RANGE OF EXPERIENCE AS A GROUP FACILITATOR:
E3. REQUEST FOR WAIVER FOR THE FOLLOWING REQUIREMENTS (INCLUDE JUSTIFICATION):



PART F
Mentor Selection

F1. Please, assign an appropriate mentor.
F2. Please, assign the following mentor: Click for list.


PART G
Potential Certification Use(s)
(Select all that apply)

G1. My Business
G2. RGB Team Member
G3. Employer Use (I understand and have explained to my employer that Licensure and Certification is NOT employer owned.)

G4. For Profit Work
G5. For Non-profit Work


PART H
Financial Arrangements

H1. I have read and understand the financial obligation for this complete course of instruction leading to independent licensure and agree to 1/2 payment in advance upon receipt of invoice.

H2. I propose the following alternative financial arrangements.



PART I
Support Arrangements

I1. I intend to operate completely independently.

I2. I intend to acquire support services from QWLC or another authorized firm.


PART J
Professional Standards Acceptance
(Failure to accept and abide by these Professional Standards is cause for rejection or termination.)

J1. I accept these standards and agree to abide by them.


When the SUBMIT button is "clicked" I certify this constitutes my full application as identified herein.
You will be provided with a receipt for this submission. It is recommended that you retain a copy of this receipt for you files.